This case involves developing a care management procedure for patients suffering from Acute Urinary Retention (AUR). The procedure presented here has actually been tried on a patient. The success of the procedure is among the reasons why it is being forwarded to the medical profession for review and adoption. The report is divided and arranged in five sections. The first section involves identifying the specific AUR problem being dealt with, which includes the patient’s medical history and risk factors that could have contributed to the current urinary disorder.
The second section entails on how patient’s medical data was collated and analyzed, as well as identifying possible causes of the problem and future implications on his health. The third section evaluates alternative solutions that were shared in the medical team as well as borrowing from the wider medical profession. This section argues pros and cons of several of the available medications procedures. Following our discussion and consultations with outside specialists, I was therefore left with full understanding of various aspects of the medication I was about to recommend. It is in the fourth section my recommendations are listed and explained to the fullest. The last section explains how the solution chosen in section four was implemented, how its results were evaluated, and how it will affect ARU procedures in the medical profession.
I. Identifying the Problem
My patient was a 72 years-old white male complaining of Acute Urinary Retention (AUR). This complication affects men over 60. The major risk factor in this disorder is male victim’s infection increases with age. Indeed, Emberton and Anson (1999) report that whereas AUR is rare in men under 60, those over 70 have one in ten (1/10) chances of falling victims, and those over eighty one in three. My 72 years-old patient was therefore in the low risk-but-venerable group. His medical records also indicated the usage of prescribed non-steroidal anti-inflammatory drugs, which tend to increase the risk of AUR in men. This could be the major contributing factor to the development of AUR disorder in his early 70s; he had been using them for a period of two years. The medical profession collates aging with ARU disorder, because prostrate glands tends to enlarge, thus block urine flow on lower abdomen (Carrie & Richard J. 1996). The patient was also suffering from a severe stress that could also be exacerbating the problem. Lack of passing urine overnight was a major concern; it could affect his kidneys and further complicate his health. This was immediately reported to the doctor, who ordered immediate examination.
II. Collating Data and Analyzing Causes and Consequences of the Problem
The patient was booked into the examination room and the following exams were undertaken:
- The doctor catheterized my patient to drain bladder and to relieve pain and pressure. This was immensely successful, as the patient was at peace during other tests.
- The ultrasound examination x-ray was performed to identify the exact location of urine blockage in the urethra, and whether the upper part of urinary track was performing normally (NIH 2007). Results indicated that the patient suffered from both urethra blockage and minor kidney malfunctions. We further inspected his kidneys to completely understand the extent at damage, if any. This is explained in the point that follows.
- Kidney tests were performed by first testing for the estimated glomerrular filtration rate (GFR), which helped us measure the level of kidney malfunction and the stage of kidney disease (NKF 2007). The patient’s GFR was established to be 91, indicating that his kidney disease was on its initial stage. According to the US based National Kidney Foundation (NKF), the first stage, with 90 or higher GFR score, can be controlled and cured. NKF adds that complexity of kidney problems increase with the decrease in GFR scores. For instance, a patient with GFR score of 15 is at higher risk that another patient whose score are 90. We also tested for the blood urea nitrogen (BUN), which measures kidneys’ ability to filter-out the waste urea nitrogen (Richards 2005). The results indicated that BUN levels were normal. We finally checked the levels of various nutrients in the blood that could indicate further indicate kidney malfunctions. All the checked nutrients (calcium, phosphorous and potassium) were reported to be normal. We therefore concluded our kidney analysis since all tests were turning out favorable results.
- We finally checked urinary functions to attest the rate of urine flow and whether the bladder was being emptied during urination. The results: flow rate was low and urine was left being in the bladder. As indicated in Section I., we think the enlargement of prostate could be the cause of my patient’s urinary problem, which was further worsened by medication of unrelated illness.
III. Exploring and Evaluating Alternative Solutions
It is important for the patient to switch medication since the current ones were exacerbating his AUR disorder. It’s also vital for him to regularly see the doctor for checks to ensure that his kidneys malfunction properly, and anomalies are addressed early. He should also start taking medication for his kidney conditions and see the doctor a week after his catheterization for medical check-ups, since 7.2 – 10.9 percent men who undergo the operation may not be able to pass urine immediately (Hassouna and Elmayergi 2005). Prostatectomy, which involves the removal of prostate and the glands around it, can also be applied to release further pressure on urinary glands that had caused AUR. Hassouna and Elmayergi further suggest pharmacological, which involves blocking “adrenergic receptors in the bladder neck” that tends to relax prostrate. They also suggest a four-year use of finasteride, which by reducing the size of the prostrate lowers the risk of experiencing AUR. But editors of the British Medical Journal (Elkabir, Patel, Vale, and Witherow, 1999) disagree. They first claim that cost implications of such medication is too high, because it would cost UK £19, 475 to treat fifteen cases in four years, just to prevent one AUR case. They further point to the low drop of patient’s mean symptom scores (the rate by which AUR symptoms disappear), which is 3.3 points compared to 19.4 points that accrue from prostatectomy procedure. The editors therefore favors prostatectomy over finasteride.
IV. Selecting the appropriate solution
The above contradiction led to intense, yet helpful, discussions within my team and other medical professionals in the hospital. A senior doctor advised against subjecting a 72-year-old patient to four years of finasteride treatment, which according to the just mentioned BMJ editors might be more costly and actually less effective than prostatectomy. This will be in addition to catheterization procedure indicated in section II, part (a).
- Implementing the Solution and Evaluating the Results
Owing to the success of proatatectomy in reducing symptom points on ARU patients, I find it worthwhile to use it on my patient. The procedure is advantageous to the patient because the removal of prostrate glands will reduce chances of developing prostrate cancer (Naito, 2005). The patient’s progress will be watched closely, as he will be reporting to the health facility on regular basis. This report will make important contribution to the medical profession, as it has made step-by-step follow up with the patient, from diagnosis to treatment. Also that given the patient’s age (72) represents a risk low-risk group that could be receiving less attention from researchers, the medical profession will have a better understanding on how to deal ARU disorders at early stages.
Emberton M. & Anson K. 1999 ‘Fortnightly review: Acute urinary retention in men: an age-old problem’ British Medical Journal (Online).
NIH 2006, Imaging the Urinary Tract,
Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/ImagingUrinaryTract.pdf
Richards T. ‘BUN (Blood Urea Nitrogen) Test,’ University of Michigan Health System
Available at: http://www.med.umich.edu/1libr/aha/aha_bunitest_crs.htm
NKF 2007, ‘Glommerular Filtration Rate,’
Available at: http://www.kidney.org/kidneydisease/ckd/knowGFR.cfm
Carrie & Richard J. 1996 ‘Self Testing Device for Measuring Urinary flow Rates’
Available at: http://www.freepatentsonline.com/5495854.html
Hassouna M. and Elmayergi W. 2005, ‘Acute Urinary Retention in the Elderly’
Available at: http://www.touchbriefings.com/pdf/1322/hassouna.pdf
Elkabir, Patel, Vale, and Witherow 1999 ‘Acute urinary retention in men: Management is more complex issue than was described’
Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1116768
Naito S. (2005) ‘Evaluation and Management of Prostate-specific Antigen Recurrence After Radical Prostatectomy for Localized Prostate Cancer’, Available at: http://jjco.oxfordjournals.org/cgi/content/full/35/7/365